Exam II
1.
Type I fibers show very little change with advancing age, with the exception of the anti gravity muscles. However, type II muscle fibers have a 25 to 50 percent reduction in the number and size of muscle fibers. Because of high concentration of type II fibers in the quadriceps and hamstrings, these muscles are the first to atrophy in older adults. These appear to be caused mainly by decreased use of these muscles and the lack of high-intensity physical activity needed to activate this fiber type.
The emphasis should be on concentrating on maximizing recruitment of motor units and promoting hypertrophy of existing muscle fibers, especially type II fibers in the muscles of the back, buttocks, thighs, and calves because there is much greater loss of muscle strength in the lower extremities (causing mobility problems) with ageing.
2.
Resistance Training- Dr. In-Hee Lee conducted a study regarding the balance improvement by strength training in the elderly population. In regards to the subjects used, ninety originally were recruited through advertising that targeted individuals 65 years or older. If an individual had severe cardiac disease or orthopedic or neurological disorders that resulted in mobility impairment – they could not be chosen for this study. Of the participants, 16 were excluded because of cardiac or muscular problems, and the remaining 74 participants were randomly enrolled in 1 of 2 groups-an exercise group and a control group. (24 of the participants eventually dropped out due to illness). They started their resistance training with 45-55% of their 1 rep max and completed 3 sets of 10-12 reps. They progressively worked their way up to 65-75% of their 1 rep max by the 11th week. The workouts consisted of leg extensions, leg curls, squat variations, full body, and step exercises. After each set, the participants were given a 30 second rest period. The main result was that the well-prescribed strengthening exercises led not only to enhanced strength but also to improved balance in the elderly persons. The results show that an exercise program emphasizing strengthening improves the static balance of the elderly. The improvement of static balance in the training group was greater than that of the control group. Balance is vital to elder individuals – and the best way to improve their balance is through resistance training. This study went through a vigorous process of choosing the right participants for this study – and after having them go through months of exercises – it was shown that considerable improvements in balance were made by the experimental group who took part in resistance training. It’s obvious that elder individuals should do resistance training. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885846/ Cardiovascular Training- Dr. Stanley Colcombe et al did a study that examined whether aerobic fitness training (cardiovascular) of older humans can increase brain volume in regions associated with age-related decline in both brain structure and cognition. Fifty-nine volunteers, aged 60–79 years, participated in the 6-month randomized clinical trial. Half of the participants were placed into an aerobic training group, the other half of the participants were placed in the toning and stretching control group. Participants in both the aerobic and control exercise groups attended three 1-hour exercise training sessions per week for the 6-month period of the intervention. The study found that elderly individuals that participate in cardiovascular training increase in both gray and white matter in their brain, regions that are often reported to show substantial age-related deterioration. In short, brain volume increased significantly. However, there were no significant changes in brain volume in the toning and stretching control group. This study simply shows that elderly individuals should partake in cardiovascular training – simply stretching and toning is not very beneficial for the brain, where as cardio was huge. This study was specific to just the brain – but it still showed that it had a great affect on the elderly participants. http://www2.pitt.edu/~bachlab/LabSite/Publications.html/colcombe2006.pdf 3.
The purpose of the Berg Balance Test is to determine the functional mobility of an individual – to see how likely an individual is to fall. An individual is to partake in 14 activities – and depending on how they do – they get a certain number of points. An individual who performs under a 45 on the test is a risk to fall multiple times – a score of under 40 means you need assistance with walking. An individual is wheelchair bound if they score a 20 or below.
i. Sitting to Standing
Being able to stand up relates to hundreds of daily activities – but I will just list the three that’s required!
1. Cooking
2. Walking
3. Getting out of a chair (most obvious one) ii. Transfers
1. Getting into and out of bed
2. Using the restroom
3. Leaving an getting into a wheelchair iii. Sitting with Back Unsupported
1. Sitting in a bar stool (or chair without a back)
2. Using the restroom again
3. Ability to maintain posture iv. Pick up Object from the Floor from Standing
1. Picking up dropped items
2. Picking up a crying baby
3. Ability to clean up a spill
v. Placing Alternate Foot on Step While Standing Unsupported
1. Walking up stairs
2. Maintaining balance while tying a shoe
3. Lifting a leg without falling vi. Standing Unsupported One Foot in Front
1. Walking
2. Moving in general, cannot move with feet side by side
3. Turning – often times requires one foot being out front

4. It seems like we here about an elder individual falling every single day – about one third of older people who live at home fall at least once a year, and people who live in a nursing home fall even more often (1). With that said, would you believe me if I told you that the fear of falling is much more detrimental to the elderly population than the act of falling itself? Psychological stability is always vital to any individual, but it is even more so to an elder individual. Their entire well being is centered on their psychological state – so if they are constantly living in a state of fear – they’re going to suffer immensely. Take this quote for example, “Excessive fear of falling can cause seniors to limit their participation in physical and social activities, so that they become physically deconditioned, socially isolated, and depressed (2). Thus, fear of falling can contribute to both functional decline and impaired quality of life. The fear of falling hurts them way more than they could ever realize. They often times decide to just sit in a chair for the rest of their lives, essentially give up on their physical well-being, simply out of their fear of falling. Community-based epidemiologic studies have found that at least 21 percent of elderly people experience some degree of fear of falling (3). At the very minimum, one in every five elders fears falling, meaning one in every five elders is at a high risk of suffering those negative side effects previously mentioned in relation to the fear of falling. That is 21 percent too many – a simple fear should not be able to do so much to a set of individuals.

What can be done to help minimize this fear of falling? There are many things one can do: talk to the elder individual about it, have an intervention, have a plan, consult medical professionals, encourage physical activity, etc. All of those could help but definitely take focus on the last one, encouraging physical activity. It doesn’t matter how well someone is physiologically if they’re in terrible physical shape – positive thinking doesn’t always get the job done. Encourage them, be there for them, keep them active, and the rest should take care of itself.
Sources
1. http://www.merckmanuals.com/home/older_peoples_health_issues/falls/falls_in_the_elderly.html
2. http://www.medscape.com/viewarticle/727267
3. https://www.healthplexus.net/files/content/2003/August/0607fearfalling.pdf

5.
The most prevalent vitamin deficiencies among the elderly population are vitamin D and vitamin B-12.
Vitamin D- Salmon, Sardines, Tuna, Oysters, Milk, Eggs, Fortified Cereals, Mushrooms
Vitamin B-12- Eggs, Cheese, Beef, caviar, Shellfish, Lamb, Seafood, Milk

Foods that contain oxalate can reduce the amount of calcium you absorb because the oxalate binds with calcium in your intestines. So, not as much calcium can be absorbed from your intestines and therefore passes right through you (AR). Foods rich in phytates can also block absorption, and they include fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates.

6.
A- Most injuries in aquatic facilities occur on the deck from slipping and falls. This can be avoided by wearing slip-resistant shoes at all times: in the locker room, on the pool deck, and in the water. Also, always move slowly! B- Hydrostatic Pressure
Advantages- It decreases swelling, increases blood circulation, increases the strength of the respiratory muscles, and improves the breathing of older adults.
Disadvantages- Clients with high blood pressure or breathing disorders may experience discomfort. So they should enter the water slowly.
Buoyancy
Advantages- The buoyancy of water decreases the weight-bearing impact of exercise. So, older adults can move much more freely in the water than on land.
Disadvantages- Buoyancy reduces stability – they easily lose control of their movements or their footing when the water is too deep.
Viscosity and Resistance
Advantages- There is resistance to all movements performed in the water. The increased resistance increases muscular tone, oxygen consumption, and the number of calories burned.
Disadvantages- Some frailer clients have difficulty moving the body or even the limbs through water because of this resistance.

C- It depends on the clients. Hearing loss does not diminish all sounds equally. The music could interfere with the instructor’s directions. If clients complain that it is too loud – either turn it down or turn it off. You can use it just as a background, but if you do play music, play something from their youth or earlier adulthood.
D- The heart rates of clients of clients exercising in a cool pool are approximately 15% lower than heart rates of people exercising on land, and 10% lower when in a warm pool. The heart rate is also 8 to 11 beats per minute slower in chest-deep water than in waist deep water. The intensity of a water exercise program should not be based on the target heart rate or oxygen consumption recommended for land-based exercise. 7. The most effective first step is to provide a warm welcome. Introduce the member to the group; if possible include some information about their hobbies and interest. Consider assigning them an experienced exercise buddy to help them get used to the routine. It may help to have everyone wear name tags when starting a new session or when introducing new members. Also, answer all questions they have before the class even starts.
8.
Use reasonable care based on a legal standard of care. Have the knowledge, skill, training, and education of an ordinary member of your profession in good standing. To minimize your risk of exposure to legal problems, you must work within your personal bounds of competence. You are responsible for knowing and adhering to the guidelines and standards established for your profession. * Be sure you are adequately and properly educated, certified, and experienced to train. * Obtain and keep current your training and certification in CPR and first aid. * Continue your education. * Have a written emergency response plan readily available. * Keep a written training record of each session and a permanent client file for each client. * Instruct your clients on proper techniques and provide continuous supervision. * Be aware of potential conflicts of interest. * Avoid any appearance of sexual harassment and do not tolerate any by a client. * Carry malpractice insurance. * Consult with an attorney. * Never photograph or record a client without their permission and obtaining their written consent.
9.
Prior to entry into an exercise program, they need to go through a thorough screening of the client’s health, physical activity, and disability status. They need to undergo pre-exercise screening – a process in which information is obtained from a new client before they undergo performance testing or begins physical training. The screening process identifies clients who have diseases, symptoms, or risk factors that require medical examination and clearance before starting a program, are at a risk of cardiac event while exercising, should be excluded from participation in a program, or should participate in a medically supervised program. The tools needed include an informed consent form, the PAR-Q, a health history and physical activity questionnaire, and other tools to evaluate a client’s coronary artery disease risk factors, body composition, and blood pressure.

10. I believe it’s quite simple actually – physical activity. I am probably the only person who will have this answer, but I truly believe that physical activity is their greatest health concern. Throughout this course we have discussed numerous times how physical activity single handedly leads to so many horrible things in older individuals; it is often the cause of a lot of the elder’s problems. In this exact same assignment, we discussed how the lack of physical activity can lead to depression, isolation, advancing age, and much worse things. What can be done? Stay physically active! Staying physically active can help prevent or delay certain diseases, including some cancers, heart disease and diabetes, and also relieve depression and improve mood. Get involved with organizations or communities that will keep you active. Attend workout classes that are offered to elder individuals, get a walking buddy and simply walk everyday of the week, choose the stairs over the escalator, get in the pool every now and then, etc. There are endless amounts of ways an individual can stay physically active.